职业铅接触致肾损伤的危险度评定  

Risk assessment of renal dysfunction caused by occupational lead exposure

作　　者：田丽婷[1] 雷立健[2] 常秀丽[1] 金泰虞[1] 郑光[1] 过伟军 李慧琪[1] 潘小海[1] 

机构地区：[1]复旦大学公共卫生学院公共卫生安全教育部重点实验室,上海200032 [2]山西医科大学公共卫生学院 [3]浙江省嵊州市疾病预防控制中心

出　　处：《中华劳动卫生职业病杂志》2010年第3期170-174,共5页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：欧盟PHIME项目（FOOD-CT-2006-016253）（本研究获得欧盟PHIME项目的基金资助,感谢项目合作单位中瑞典Lund大学Staffan教授和Umea大学Ingvar副教授,浙江省嵊州市疾病控制中心职业卫生科工作人员在课题的职业流行病学调查中给予了帮助,志谢）

摘　　要：目的 通过职业流行病学调查和基准剂量计算,对职业性铅接触所造成的肾损伤进行危险度评定.方法 以浙江某蓄电池生产工厂239名工人为接触组,同地区某厨具厂工人76名为对照组,对工人开展问卷调查与体格检查,采集生物样本.收集车间空气中铅监测资料,计算工人在车间中接触的铅的总量,考查铅外剂量与内剂量之间的关系;以外剂量（铅参考接触剂量）、血铅、尿铅为接触标记,以尿中N-乙酰-β-D-氨基葡萄糖苷酶（UNAG）和尿白蛋白（UALB）（均以尿肌酐进行校正）为效应标记.采用基准剂量计算软件（BMDS 11311）计算基准剂量反应为5%时,各效应标记的血铅、尿铅基准剂量.结果 铅的外剂量与内剂量呈正相关（血铅：r=0.466,P〈0.01;尿铅：r=0.383,P〈0.01）,铅接触组的血铅、尿铅水平分别为654.03μg/L、143.45μg/g Cr,明显高于对照组（分别为57.12μg/L、7.20μg/gCr）,且呈剂量-效应关系;按照对照组效应指标的95%上限为参考值上限,求得各效应指标的异常发生率与接触指标呈剂量-反应关系;UALB、UNAG的血铅BMDL-05分别为607.76、362.56μg/L,UALB、UNAG的尿铅BMDL-05分别为117.79、78.79 μg/Cr.结论 职业铅接触可致肾损伤,且呈剂量-反应关系;使用计算血铅、尿铅BMD的方法能进行职业铅接触的肾损害危险度评定.Objective To assess the risk of renal dysfunction caused by occupational lead exposure through epidemiological investigation. Methods The workers in a battery factory were selected as the subjects for the exposure and effect assessment. The occupational environmental monitoring data was collected and used to calculate the total external dose of lead. The relationship between external dose and internal dose of lead was analyzed. The external dose, blood lead （BPb） and urinary lead （UPb） were used as exposure biomarkers while the urinary N-acetyl- D-glucosamindase （UNAG）, and urinary albumin （UALB） were used as the effect biomarkers for the renal dysfunction caused by lead. Software of BMDS （BMDS 11311） was used to calculate BMD.Results The external and internal does of lead was positively correlated （BPb： r=0.466, P 0.01; UPb：r=0.383,P〈0..01）. The levels of BPb, UPb in exposure group （654.03 μg/L,143.45 μg/g Cr） were significantly higher than those in the control group （57.12 μg/L, 7.20 μg/g Cr）, so were UALB, UNAG; in addition, all of them presented significant dose-response relationship. The BPb BMD of UALB, UNAG were 607.76, 362.56 μg/L respectively and the UPb BMD of UALB, UNAG were 117.79, 78.79μg/gCr respectively. Conclusion Occupational lead exposure can cause renal dysfunction, which presents dose-response relationship; the risk assessment of renal dysfunction caused by occupational lead exposure is performed by BMD calculation of BPb and UPb.

关 键 词：铅 乙酰氨基葡糖苷酶 白蛋白类 危险性评估 

分 类 号：R686[医药卫生—骨科学]